A clinical follow-up study on bronchiectasis in 116 children, who had been diagnosed between 1951 and 1971, showed the following results:
1. Subjective course and prognosis:
Coughing, sputum and other respiratory complaints were remarkably reduced in both operated and non-operated groups and almost 80% of the patients feel recovered from their pulmonary disease and spend a normal school life or are able to work without any trouble.
2. Objective course and prognosis:
In the non-operated group, bronchographic findings showed that the ectatic bronchi still had remained in all cases after 1-21 years process and furthermore, newly ectatic bronchi were noticed. In the operated group, bronchographic findings showed that no ectatic bronchi had appeared in completely resected cases, but in incompletely resected cases ectatic bronchi had newly developed or ectatic tendencies were noted. Pulmonary function tests such as vital capacity, one-second forced expiratory volume and maximum voluntary ventilation revealed no remarkable differences between the operated and non-operated groups. Normal volume was noticed in the completely resected group, but in the non-operated group, residual volume had increased.
3. General results:
In the non-operated group, no one had recovered completely and only 28.6% had slightly improved, 42.8% were almost unchanged and 28.6% had deteriorated. In the operated group, 50.0% had almost recovered completely and of the improved cases almost 83.3% proved to have good prognosis, but 8.3% unchanged and 8.3% deteriorated cases were noticed. Considering the objective and subjective data, it is clear that there is a great discrepancy between the results of the objective and subjective course and progresses. This is an important point in seeking to cure bronchiectasis in children. Considering these points, 1 suggest the three following major principles in the attempt to cure bronchiectasis in children:
1) Complete resection of the invading focus should be performed after bronchography examinations and full consideration of the post operative pulmonary function.
2) Operation should be decided after observing irreversible changes of the bronchus after six months or one year follow up.
3) Treatment of bronchiectasis in children should be combined with antibiotics, drainage, treatment of complication and so on when necessary.

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A 47 year-old male with bronchial asthma (case 1) received a total of 1080mg gold-thioglucose, when dry cough and exertional dyspnea was observed. Neither fever nor acceleration of ESR existed. Chest roentgenogram revealed confluent interstitial infiltrations in the upper and middle field of both sides. A histological diagnosis of chronic interstitial pneumonitis was made by open lung biopsy. Discontinuation of chrysotherapy resulted in improvement of the symptoms and roentgenographical findings.
A 75 year-old male (case 2) with arthralgia of the right foot (no other joints were involved) was given injections of gold-thioglucose. He developed exertional dyspnea and cough when the total dosage amounted to 1310mg. Chest roentgenogram elicited bilateral interstitial shadows confluent in the middle lung fidld. Neither fever, nor acceleration of ESR were presented. Open lung biopsy revealed chronic interstitial pneumonitis. Cessation of gold and prescription of corticosteroid resulted in slight improvement of symptoms and of chest X-ray. Non-destructive radioactivation analysis was used to determine the gold concentration in six autopsy lung specimens obtained from three RA patients who had received 8500mg, 790mg and 180mg of gold-thioglucoe respectively. The gold concentrations of specimens from case 1 and case 2 were found to range between the values of the controls which had received 8500mg gold and 790mg. There was no history of noxious gas inhalation, viral infection nor ingestion of drugs which may cause pneumonitis. In case 2 the diagnostic criteria for RA (American Rheumatism Association) were not fulfilled, accordingly rheumatoid lung could hardly be considered. Because of the appearance of this ailment during chrysotherapy, and the fact that some regression was seen after its cessation, there is a possibility that the ailment was caused by chrysotherapy, and susceptibility or individual disposition for the disease may play an important role rather than the gold concentration in the lung tissue.
Eight guinea-pigs were given an intravenous injection of 2mg gold-thioglucose, and were sacrificed after 3, 24, 72hrs. and 8 days. Infiltration of neutrophile leucocytes in the alveolar walls and alveolar spaces, with intraalveolar hemorrhage and edema were seen in the early stages followed by large mononuclear cell infiltration and thickening of the alveolar septa in the late stage. Six guinea-pigs were given intramuscular injections of gold salts or an oil solution of gold salts weekly for eight weeks. Their lung specimens showed various types of interstitial damage.
Only eight cases of interstitial pneumonitis ocurring during chrysotherapy have been reported to up now and the possibility that these were caused by the gold is discussed. Taking into account their clinical courses, the gold concentration in the lung tissue and the pathogenesis of other untoward effects during chrysotherapy, it is suggested that immunological phenomena may play the most possible role in the pathogenesis of this disease.

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Episodes of acute bronchial asthma and shock following the injection of tetracosacide-Zn (TC-Zn), a synthetic ACTH, were described in two bronchical asthmatic patients.
Case 1, a 45-year-old male, had experienced long-term corticosteroid treatment causing pituitary adrenocortical suppressions and case 2, a 62-year-old female, had received corticosteroids without any such drug-induced suppression. Case 1 received a combined therapy of 0.1mg/day of TC-Zn with 0.75mg/day of betamethozone for 20 days. Case 2 received a single therapy of 0.5mg of TC-Zn once a week for several months because bronchodilators had not shown any effect.
During TC-Zn therapy, case 1 suffered an acute episode of bronchial asthma and case 2 showed shock symptoms. After these episodes, both cases were given a skin test of TC-Zn and a Prausnitz-Künstner (PK) test. Case 1 showed a positive skin reaction, but a weak positive PK reaction. On the other hand, case 2 showed a negative reaction to both tests. It should be noted that these adverse side-effects were found after about 20 TC-Zn injections.
Although such adverse reactions are rare and the etiological factors could not be determined, physicians are recommended to remain alert to the possibility of these reactions.

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The patient was a 62-year-old male clerk admitted to the chest clinic with a slowly progressive lung disease of about a five year duration. He was asymptomatic although the chest X-rays showed a diffuse nodular pattern throughout the lungs. Laboratory examinations revealed a hypergammaglobulinemia of 4.8mg/dl, a positive rheumatoid factor, an increased IgG over 4, 000mg/dl, and IgA of 600mg/dl and a normal IgM.
Skin tests to PHA and DNCB were negative, although a PPD_s tuberculin test was positive. T-cell count showed a decrease in association with a weak response of lymphocytes to PHA, revealing an impaired cellular immunity.
A lung biopsy disclosed that the pulmonary interstitial tissue was infiltrated with plasma cells and lymphoid cells and also had a proliferation of lymph follicles. Scalene node biopsy also showed proliferation of plasma cells. All these findings were interpreted to be consistent with lymphoid interstitial pneumonia. Prednisolone therapy was started but did not affect the chest X-ray findings.

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Two cases of bronchiectasis accompanied by underdeveloped frontal sinuses in young identical twin sisters were reported. The clinical pictures of their diseases were almost identical.
The role of the congenital factor in the etiology of bronchiectasis was discussed.
Although the etiology of bronchiecsasis is still uncertain, it seems from both the clinical and the genetic aspects that different factors may well be involved in different patients. The concordant occurrence of bronchiectasis in identical twins, and a familial history of bronchiectasis, suggests that genetic factors play an important role in the etiology of bronchiectasis in some cases at least.
A case report and a review of related literature are presented.
CASE REPORT
Family History: The twin sisters were born in 1954. One of their brothers and a maternal aunt had chronic nasal sinusitis. There was no consanguineous marriage in this family.
Proof of Monozygosity: The appearances and the clinical pictures of the twins were almost identical. We could not tell them apart when they were examined.
Further strong evidence of monozygosity was obtained by testing their blood group, and taking their fingerprints and x-rays of their frontal sinuses. Both twins had type A blood. The finger-prints of the right thumbs and indexfingers, were compared and found to be completely identical. The shape and size of their frontal sinuses also were identical. The twins had been informed by their mother that they were identical twins which suggests that the midwife confirmed the monozygosity by examining the placenta at their delivery.
Case 1: In May 1972, at the age of seventeen years, this twin was suspected of having pulmonary tuberculosis on a pre-employment x-ray checkup whereupon she consulted our clinic.
She, apparently a healthy girl, 141cm tall, weighing 40kg, stated that she had had measles, mumps and pneumonia in her early childhood, and that she had only a small amount of sputum ever since. But the history of recurrent exacerbation of respiratory infections was not elicited.
A plain chest x-ray showed slightly increased pulmonary markings in the right lower lung field, but otherwise no abnormality. Bronchography demonstrated bronchiectasis in the bronchi of the right middle lobe, the left lingula and the lower basal segments. Her frontal sinuses were underdeveloped.
Case 2: The other twin sister was 142cm tall, and weighed 42kg. Case two came to be examined even though case two did not have any symptoms. They were as like as two peas in a pod.
Her past history disclosed that this twin suffered measles and mumps at the same time as with her sister. The chest film appeared to be normal. Bronchographys demonstrated bronchiectasis in the right middle lobe bronchi. Her frontal sinus was underdeveloped. The bronchial dilation in the right lung and the roentgenographical appearance of the frontal sinus were identical in both twins. Bronchography of the left lung was not undertaken.

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